When you receive in hospital treatment, the benefit we pay towards medical services is based on the Medicare Benefits Schedule (MBS), which is set by the government. If a service is listed on the MBS and included on your cover, Medicare will pay 75% of the MBS fee and we’ll pay 25% of the MBS fee.
A doctor may choose to charge more than the MBS fee. This may leave you with an out-of-pocket expense commonly referred to as the ‘gap’. The good news is many doctors participate in a scheme called GapCover, which is a designed to help eliminate or reduce your out-of-pocket expenses for in-hospital doctors’ charges. Further information on how you can reduce your out-of-pocket medical expenses can be found here.